Question

A one and a half year old girl child, fed mostly on dilute cow's milk, develops diarrhea that continues for 10 days. She then develops swelling of both feet, and the picture is diagnosed as kwashiorkor. The most important aspect of her management is

• A. Diuretics
• B. Fluid restriction
• C. Diet with adequate calories and protein
• D. Potassium restriction

Hint:

Think about what is actually missing in a child fed only dilute cow's milk.

Answer 1

The Correct Option is C

Step 1: Read the case and reach the diagnosis.
The girl is 1.5 years old and was fed mostly on dilute cow's milk, so she got very little protein for her age. She develops diarrhea that lasts 10 days and then swelling of both feet. Feet swelling in a malnourished child means low blood protein pulls fluid out of the vessels into the tissues. This picture, a poorly fed toddler with diarrhea and pitting edema, is classic for kwashiorkor, a severe form of protein energy malnutrition where calorie intake is close to normal but protein intake is very low.

Step 2: Recall what kwashiorkor needs.
The child's body has run out of protein stores. Muscle wasting, low serum albumin, and edema all come from this protein gap. The single most useful step in treatment is to correct this gap: give a diet with enough calories along with enough good quality protein, started slowly and built up over days so the gut and metabolism can adjust. Going too fast can cause refeeding problems, so nutrition is increased in a stepwise way, but the core action is nutritional rehabilitation.

Step 3: Rule out diuretics.
The edema here is not from fluid overload or heart or kidney failure. It comes from low oncotic pressure due to low albumin. Diuretics would pull out fluid and salts from a child who is already depleted, and would not fix the real problem, the missing protein. This can make the child worse.

Step 4: Rule out fluid restriction.
This child is not fluid overloaded. She needs building blocks for recovery, not less fluid. Restricting fluid does nothing for the protein deficit and can worsen dehydration from the ongoing diarrhea.

Step 5: Rule out potassium restriction.
Children with kwashiorkor usually have low total body potassium because of poor intake and losses in diarrhea, not high potassium. Restricting potassium further would be dangerous and is the opposite of what is needed.

Step 6: Final answer.
The most important step in managing this child is a diet with adequate calories and protein.
\[ \boxed{\text{Diet with adequate calories and protein}} \]